Neuromodulation and Electrophysiological Monitoring in Headache Management: Current Advances and Future Perspectives

Dong Qiu; Xi Liu; Wanting Lu; Fuyu Liu; Wei Wang

doi:10.71321/vah93v44

Authors

Dong Qiu Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
Xi Liu Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
Wanting Lu Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
Fuyu Liu Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Wei Wang Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

DOI:

https://doi.org/10.71321/vah93v44

Keywords:

headache, neuromodulation, electrophysiological monitoring, neuroimaging

Abstract

Headache disorders such as migraine are major causes of disability worldwide. Pharmacological treatments are often insufficient, particularly in resistant or refractory cases. Neuromodulation techniques, including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and peripheral approaches such as occipital nerve stimulation (ONS), trigeminal nerve stimulation (TNS), sphenopalatine ganglion (SPG) stimulation, and non-invasive vagus nerve stimulation (nVNS), offer promising alternatives. Electrophysiological methods including electroencephalography (EEG), magnetoencephalography (MEG), evoked potentials, and TMS combined with EEG (TMS-EEG) provide mechanistic insights and potential biomarkers for treatment monitoring and personalization. Here, we summarize emerging findings on neuromodulation and electrophysiological biomarkers in headache disorders, highlight their mechanistic underpinnings, and propose future directions for optimizing individualized treatment strategies. Key challenges remain, including small sample sizes, heterogeneous stimulation protocols, and limited long-term data. Future research should prioritize multicenter randomized controlled trial (RCT), closed-loop neuromodulation, and multimodal integration to advance precision headache medicine.

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